Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Wednesday, December 26, 2007

Here’s some free advice: Don’t get so fucking fat that when you die, your family has to deal with your ginormous whale-carcass.

One of my local pathology colleagues had a gastric bypass patient die today – he was 45 years old and 780 pounds. I think his BMI was, like, a trillion.

Listen, I have nothing against fat people. First of all, fat chicks love to have sex, and are good at it, because they are so grateful for the attention. Second, fat people get sick and die more often, which is great for business. Third, and most important, fat people are great to make fun of.

Here’s the problem with the morbidly (mortally?) obese: there is nowhere to put your fat ass when you die. This dude was rejected by multiple funeral homes because (and I’m not kidding) he risked exploding their crematory furnace. You see, fat is flammable; if you have witnessed a grease fire, you know what I mean. The family was too poor to pay for the double cemetery plot and the extra manpower required for burial and transport. The dude would not even fit into the refrigerators in the morgue – they had to wall off half the room in plastic and pump refrigerated air into a jury-rigged plastic bubble.

They are calling the local zoo to see if they have animal crematoriums. If this doesn’t work, they are going to end up having to cut this guy into pieces and burn him up a bit at a time. Again, not kidding.

So, listen up fatties: put down the extra large Mr. Pibb and step away from that Hardee’s Monster Thickburger. Your family will thank you when you are dead.

103 comments:

I kid you not, recently we had a big boy (?480 ?550 pounds, who knows) sit down on our ER public-use toilet, causing it to shatter into a million pieces. There was porcelain and toilet water everywhere.

Another reason not to get fat: You're playing Russian Roulette with public toilets. At least it shattered right away before he had a chance to take a sh*t.

Thank you for the mental image. Nothing motivates me to lose the last twenty pounds like watching all the Obese People shows on TLC and Discovery Channel. This helps even more. You've done a public service.

Yet another reason I am SO damn happy I lost weight. (200 pounds the old fashioned way - my GP has an orgasm every time he sees me.) The best 15 grand I ever spent was having all my various parts put back where they belong :) (Hello breasts! Good to have you above the equator again!). If they only knew how good they would feel, damn... I feel 16, act 16½ and dress like im 20. Life is so fucking sweet. Why I wasted 10 years on binge eating is still a mystery, I just know I'm never going back.

mow, I often used to lament that whatever my addiction was, why did it have to be reflected on my waistline for all to see? I mean why couldn't I be a compulsive gambler or a plush animal fetishist, a closet nose-picker or some pathologist's scrotal waxer? At least I'd still look good and not be publicly villified.

In defense of medical personnel, they are the ones who have to deal with the supersized citizenry when the inevitable happens. It makes them cranky.

So this is how the docs talk about their obese patients behind their backs, eh? It isn't enough that there are so many lectures and looks of consternation and assumptions about your medical condition(s), whatever they might be...?

Yes, I, too, have seen those programs about people so gargantuan that they can't even move, much less practice proper hygiene. It's truly sad and pathetic. The underlying problem is a cultural one, though--we've dwindled down our opportunities to move while simultaneously exploding our caloric intake, which results in that morbid obesity problem you so *eloquently* describe. But...how can people even begin to think about getting help for such things when they know their doctor is going to treat them like a child needing discipline? The paternalism is blatant and inappropriate, and it probably keeps many an obese patient out of the doctor's office until they are beyond reasonable help. Hence the explosion in the popularity of bariatric surgery...

I saw some of that paternalism firsthand, and I'm not even technically "morbidly" obese. Until we collectively get our heads around the idea that we need to get up off our butts and eat more healthful foods, this problem will continue. Having physicians be so totally judgmental or ridiculing will not help, either. Give patients tools to help themselves, rather than snarkiness. Ok, rant over.

think about having to push these people from the ED to the ICU, and then you lose their big boy son in the twists and turns of the hospital because he can't keep up and spend the next hour trying to find them.

Here's the 411:You can't tell people, especially in the ED, that they are fat and need to loose weight. Either they know they are fat, or they will complain to admin that you insulted them. Most are in denial that their 450 lbs of girth is causing their knee pain. There has to be another reason. Also if you are very fat, you fat yourself out of healthcare. No MRI, no cath, no CAT scan, no nuc med, no nuthin'. So don't get mad at us when we are having trouble burying that central line through 1 foot of fat and still can't get venous access. Aside from the actual 0.1 % of the pop with a "gland problem", fat, along with ETOH and smoking and crack, is a choice, as is skinny. But like everything else in this blame the other guy, lawyer-up, socialist, victim-group world in which we live, it's always someone else's fault. As for the one's over 400 who can't walk, obviously there is a Dr. Phil co-dependent/enabler relationship at work there.

Cat, what you said. Just had a case to graft the wound of a diabetic patient who had an infected toe and metatarsals amputated. He had previously been morbidly obese, got a lap banding, lost 100+ pounds, lost his fifth digit and got scared. Made the correct choice to do everything that the docs had been telling him to do to change his lifestyle and work towards better health lest he lose half a foot or the entire lower leg. Don't know the guy yet I am extremely proud of him because he is the exception. Noncompliant obese/diabetic patients are the norm and we have to just keep hacking away at extremities.

Be accountable? Take personal responsibility? Exercise self-control? Why bother, just make the rest of the world work around you.

People ask how I lost weight, expecting some pill or surgical procedure, hypnosis, whatever. Inevitably, their eyes glaze over when I tell them I got off my ass and shut my mouth. I actually let myself experience hunger. The Glycemic Index was a tremendous help. (I know it may or may not be as effectual as first thought, but it provided structure and gave my OCD something to chew on.)

If I can do it, anyone can. It was hard work, every damn day. Losing was only the beginning, now I have the rest of my kick-ass life to keep it off (3 years and counting).

I don't miss the derision, the snickering, the staring, the self-loathing, the isolation, the immobility and the fear. The very worst was the looks of pity from people.

It's difficult not to view harshly people who refuse to control themselves. Add to it a shitty, entitled air of impunity and one quickly loses all patience with these people.

This forum and many like it are a way to exorcize these feelings in a safe environment. I'm willing to bet that by far most medical personnel treat their patients humanely. (I was always treated nicely)

My husband lost over 100 pounds (an entire me worth of weight) while I was pregnant with twins. I was really proud of him, although his timing sucked because when I was done having the twins, everyone we saw commented on his weight loss instead of mine. I have never been heavy, in fact I have sort of the opposite problem, but I am sure losing weight is really difficult for a lot of people. I thought this post was funny, but since I have never been heavy I didn't think I should comment on that for fear that someone would then start telling me I had no idea what it is like.

medreclegal, at your request... tools to help themselve. nutrisystem, weight watchers, excercise, gastric bypass or lap band procedure. took me a while to find these on the web, but, apparently, they work. one other things that really pulls off the weight is crystal meth. unfortunately it cuts life expectancy quite remarkably. toodles.

About the only thing sadder and sicker than an obese person who has lost all will to help themselves, is a medical "professional" who uses them to get a few laughs and winks, from the worst nurses on the entire internet.

correction, anonymous, and i agree that it's easy to get a laugh from the morbidly obese, especially when you have to take care of them at the end of their lives and they still have not, evidently, appreciated that their acute on chronic fatness is killing them. let's face it, it's either laugh or cry at them and since they are everywhere i choose to laugh.

but there is one thing sadder, it's the anonymous trolls who are the self-proclaimed schoolmarms of the internet. finding offence and penning complaints without ever revealing their identity. they are, like trolls, usually fat, live in the shadows, and are huge pussies.

For all the self righteous out there, I'll share my personal philosophy as a FF/Medic: every patient I deal with, whether it is a sweet granny or a 20 yr old big mouth welfare queen with a hangnail, gets treated with respect and dignity, usually far beyond what they appreciate or deserve. I am able to do this because I can blow off steam elsewhere, whether it is in the firehouse or at the ER between calls. Remember, medical professionals are the ones who are exposed to their infectious diseases, shat and pee, while ruining our backs trying to lift them with 2 people because the taxpayers are unwilling to pay for what is needed. Give the docs a break.

At the prisons they have stainless steel commodes..without lids...but they can still pull our of the concrete walls with enough weight. If the insurance companies start pentalizing patients for being overweight, making them pay more and/or cancelling their insurance, there may be changes. But then of course, uninsured they will get plenty of good care for free. Darn, catch 22.

As a former "fat chick": hell, I wish I were still fat. It would be a hell of a lot better than losing 20 lbs/month because of a digestive disorder that my doctor still can't really explain, and having people tell me, "That's so great! I wish I had your problem!"

It seems like every woman who weighs more than a hundred pounds has this attitude. They continue to say these things to me even as my ribs begin to protrude, my energy begins to flag, etc. As a doctor, doesn't this worry you? Do you really feel you're "doing no harm" by encouraging this disordered attitude towards food in the name of "ha-ha-laugh-at-the-fatties"?

The greatest thing of all is that nobody is forced to be a doctor or a medical professional, it is a matter of personal choice. If it is all too much you could choose to specialize in working with anorexics or possibly people in the last stages of cancer, thereby mostly avoiding fatness. And protecting your delicate sensibilities.

Being a little heavy vs. being 500+ lbs. is quite different. And sarah is right, lifestyle change and NOT diet is the answer to weight management. Thank you for the update, oh all-powerful and wise overweight sage. Lifestyle choice is ALL ABOUT personal responsibility. You are obviously very sensitive toward being fat. Deal with it or stay fat stop whining.

As for the former fat chick with the wasting disease, are you really equating sound advice about weight management with encouraging someone to get sick to lose pounds? Are you high? Is that why you have the munchies all the time?

Look folks, this dude ATE HIMSELF TO DEATH! I mean, that, by definition, is FUNNY. Why do you not get that?

This man obviously had a problem, no one who was emotionally and physically healthy would actually eat themselves to death. And whatever his problem was, (food addiction, some other eating disorder, mobility issues, thyroid issuess) went treated with nothing but "Hey fatass, learn to diet." And so apparently he died, because the medical community failed to find a way to help him. And that's Funny to you?

If you think that's funny, then I've got another one for you. I is just HILARIOUS, You've heard about those Women who STARVE themselves to death so they can be models. That freaking CRACKS me UP! THese chicks just STOP EATING so they can fit into clothes, and then they DIE! HAH I bet we could fit like 8 of them into a coffin and save a few bucks!

Oh wait, but Those women have problems, they have disorders, this fat guy who couldn't stop eating, he was just a lazy asshole.

Stupid rhetoric. You're not going to go on a diet because you know you don't have the power to succeed. At least put the blame where it belongs.

"The fault, dear Brutus, lies not in our stars but in ourselves."

This discussion happens to be about morbid obesity. It is an obscene corruption of the greatest gift a person has. I'm sure the people who have to deal with these patients are just as irritated by all the other self-destructive lifestyles out there... but they don't have to break their backs picking them up off the Goddamn floor.

It's that attitude "Hey I ate myself to 600lbs/gorked my brain on coke/drank my way into an embankment/starved myself into kwashiorkor/etc... etc... now FIX ME... and DON'T expect me to make any sort of sacrifice or take any sort of responsibility" ...it makes Drs and Nurses (and me) cranky.

The tone of this blog is not for the thin skinned... you know these guys don't walk around mooing at fat ladies or slapping the Big Macs out of people's hands. It's their forum, read it or don't read it, but deal with it and shut the fuck up with your fucking whining.

You know, I am a big guy myself (bout 350) and besides having hypothyroid, I am completely healthy. I can walk around, I can play with my dog, I can even sit on toilets that don't shatter. It sucks that this guy got so big and that your friend had to deal with it. But it goes with the job description.

I have a funny story too. I used to be a chef, not a cook...but a chef. I ran my own kitchen. Anyway...every single night I had to put up with uppity bungholes who felt that their food was wrong, or that something was wrong when it wasn't. One night,a curly haired blonde woman pulled out a curly blonde hair from her food and actually called me from what I was doing to scream up and down at me. She claimed that it was mine, proceeded to insult me...including some very awesome fat jokes. I put her unsatisfactory food in a to-go container, and kicked her right out. The owner of the joint was backing me up 100%. Is it fair that I had to deal with all you uppity douchenozzle types all night? Is it fair that I have to put up with your bigotry and hateful banter? No. But it goes with the job description. Deal with it.

By the way, that bypass patient pays your bills. This is a truly disgusting post. We are all human and all in this together, when you have to push soemone else down to make you feel stronger, you are truly the weak one. It's appalling. By the way, he's dead and your making fun of him. Do you feel good about yourself?

yes, it does go with the job description and i am "dealing with it". If you can't see the humor in people's fucked up behavior then you would not last 3 seconds in medicine. And anorexia is HYSTERICAL... (it's called hyperbole genius - look it up.)

After the horrible crap you just spewed makes me want to never trust a medical professional again. Shame on all of you for the hateful words you have said here. Of course you will never understand why it's so hateful because it seems that you think that because you have a specific education that you are infaliable.

*sigh* Back to your mockery of those whom you have given an oath of "first doing no harm", because of course no one will ever find this page and realize you are talking about them and be harmed in any way.

Read "How Doctors Think" by Jerome Groopman. His philosophy may benefit you. I am certain Dr. Groopman would NEVER say such cruel things about his patients, even if it were in the "privacy" of the Internet.

Speaking cruelly about another human being because of his/her body shape and health is tantamount to using racist, sexist, xenophobic, homophobic, and other types of bigoted, oppressive speech. For the sake of your profession and your practice of medicine, I hope you will seriously consider that idea, and invest in a paper journal and an ink pen. If you need to vent, that would be the appropriate place to do so.

By the way, I'm a size four, so you can save the OMG FATTY FATTY FATTY jeers (if that will help you take my words seriously, because clearly, if I were a fat woman, I would also automatically be stupid).

You know, if you just stumbled upon this blog then you don't have the context to know ETOTHEIPI is a cynical, smart, funny, pathologist. He deals with the end result of disease and poor choices every day. He has a twisted sense of humor.

That being said, if you find this particular post offensive then GO THE FUCK ELSEWHERE!

All the doctors on this blog have spent at least ten years in practice and have been named in malpractice suits exactly ZERO times. Given that we practice, with the exception of ETOTHEIPI, in a high-risk, high-acuity field... Emergency Medicine... that's gives us pretty good street cred. in terms of our skills.

If any of you have come here to hear anything less than what's in the little bubble above our heads when we meet people like the half-ton patient described above then GO BURN SOME WEED AND TURN ON THE TUBE!

So many of you posting about the 'lack of caring' etc... here are already doomed and I know what I have to say here won't change your mind but what the hell?

ETOTHEIPI has given you a rare opportunity to see the very sad, short life or a morbidly obese patient who had given up. They just gave up. The poster who said they wouldn't diet has given up too. This is not where people who have given up should come for their daily affimation.

This is not the place to trot out excuse number 87 as to why you are still fat, still addicted, still smoking, still living in a trailer, still married to the abusive husband, still waiting for a dentist who will treat you for free to fix your bad teeth, still waiting for the government to fix your problems, still waiting for the government to get even for you with folks like us, or still waiting for your twenty-three year old to move out of the house.

Really, for you 'external locus of control' people (those of you who do not own your problems as of your own creation) LEAVE AND DO NOT COME BACK OR WE WILL CONTINUE TO RIDICULE YOU and the best you will be able to do is call us names or tell us that we are 'uncaring' or 'bad doctors'.

Boy, those just fall on deaf ears especailly after the four little old ladies and one three-year-old that my nurses and I rescued from the brink of death just this week!

It turns out... And i know this is going to be... like... really hard for the last poster to comprehend. But, this is the internet. So when you post something on it, that means other people will read it. And then, people who disagree with it, will link it to other people, who also disagree. And then, they all show up on your blog and bitch. And that's just part of the deal when you have a blog. Welcome :-)

I in fact came here, specifically, to respond, to ETOTHEIPI's post, and for no other reason. I think, it is important that he know, that I think that his commentary on this individual is reprehensible. Does that mean I'm going to stop him from thinking asshole things about fat people? Or posting asshole things about fat people on his blog? No.

If he doesn't want me to post on his blog about how he is being insensitive, then he should turn off the comments, or implement a comment moderation strategy. (Or not be insensitive, that's an option too.)

Blogs are public, on record, and on the internet. If you can't deal with people disagreeing with you from time to time then you should find a more warm fuzzy place to express your opinions.

I didn't come here for validation, I came here to tell someone off. Long, Short.

Also, as much as I appreciate the definition of hyperbole, that doesn't change my point. Fat people who die from their disorder are still no less deserving of respect than skinny people who die from theirs.

uh, 'shinobi', uh, like, the 'last poster' is me... the founder of the blog... the blog that's been up for over two years now with your first post coming within the past few days. thanks for the condescencding explanation about what blogs are about... i had no idea.

you do a lot of asserting without demonstration. i happen to agree with you that all people are deserving of respect regardless of their personal appearance etc... but you have given our readers no reason to believe why this should be so.

that being said, some people burn up their default respect by repeated poor choices. hence, while i might meet patient 'A' in March and really connect on an emotional leve with their pain and sadness which caused them to slash their wrists, i might have less respect and less pity for them the fifth time i see them for the same thing.

hence the dead fat patient of this post. you do not get to weigh nearly 800 pounds in a flash. there are warning signs along the road. this person had ignored all of them and therefore has lost the default respect he would have been granted five to ten years ago when he started his long march to obesi-death.

i reject, completely, that people always deserve respect. people can, and should, lose respect.

Re: this comment: "I will bet a lot of money that you are fat chicks. Go on a diet and shut your yaps." Your insensitivity is not surprising; it is incredibly common in the medical community and elsewhere. Sometimes I find you guys pretty funny; this just wasn't one of them. Perhaps you just see so many cases like this that you've become hardened. Ridicule and derision is not the answer. I'll give you the benefit of the doubt and hope you're not really so callous.

Addendum: I have certainly not given up and reached the point of your unfortunate patient. This was a case of clearly pathological proportions, someone losing complete control over their intake. Perhaps he did abdicate personal responsibility at some point, and obviously his choices were poor over the long term, but you still come down awfully hard on him here. As for ownership of problems: that is, IMHO, a cultural problem that is spreading like an insidious epidemic in this country. On that we agree.

And 911 Doc: It's obvious you've been working with humanity for far too long. I can totally relate to that, but I'd never tell someone to "fuck off" unless they really got on my last nerve. Maybe its the cynicism that's a little bit of a turnoff, but I can understand its origins. It won't keep me from coming back for more snarkiness, however.

Read 911's commentary above for any 'explanation' for this post. Well said...

Of course I'm incredibly harsh on this blog. Some people will find this offensive, others will find it amusing. I enjoy reading stuff like this because it can (sometimes) expose a brutal truth while (sometimes) being funny.

If you can't find the humor in caring for and HELPING the uneducated single mom with 6 kids, the cachectic heroin junkie, the 800 pound dead guy in your fridge, or the hospital administrator (worst of the lot), then the soul crushing tradgedy you see EVERY FUCKING DAY will put you up on the ledge with a gun in your mouth.

Yeah. You will hear some harsh shit on this blog. Don't worry, if you see us in the hospital we will save your life while you spit on us and bemoan how callous doctors are. So, to be brief, fuck off.

BTW, in real life I'm all rainbows and puppy dogs - it's all just an act.

here we are, warts and all. i will tell people to 'fuck off' when and where i please but will try to do it, in the future, in a nicer way. how about 'fuck the opposite of on' or 'intercourse off' or 'for unlawful carnal knowledge off' or 'coitus off' or 'rhymes with truck-off'. there.

My assertion is not that all people are deserving of respect. That is demonstrably not true. My assertion is actually that fat people who die from their conditions are just as deserving of respect as thin people who die from them.

People who starve themselves to death have just as many warning signs that they are on the road to their own demise as people who eat themselves to death. Anorexia and Bulimia are hardly without side effects. I am limited in my knowledge of them to experiences with my close friend which involved multiple hospitalizations for related issues before she would get help to save her own life.

Yet somehow, when an anorexic model ignores these signs we hear about how sad it is. Poor girl just wanted to be thin so badly she killed herself. Perhaps I missed the jokes on various blogs about the hilarity of her death and am therefore misinformed.

When obese people die because of their condition, it's a great joke. Did you hear the one about the guy who had to be lifted out of his house by a crane? I laughed for milliseconds.

Frankly, I think it is incredibly sad that someones life got to this point, no matter who was to blame. But it is even sadder when things like this are mocked and turned into some kind of "warning: do not feed the fatties" sign.

Now perhaps I am overly harsh, perhaps you all, being the fair minded medical professionals that you are would have something similar to say about the anorexic or the suicide victim. I'm not asking you to respect everyone,

I'm ultimately asking you to look and see if maybe you are a little less respectful of fat people than they deserve in comparison to others. Maybe the FAT guy is just a little "funnier", because he's little more socialy okay to hate on than the skinny chick.

no to put too fine a point on it anonymous, but, admittedly with some profanity laced tirades here, all the discussion has been angry, to be sure, but has basically centered around the argument that we shouldn't make fun of fat people.

i did, along with etohteipi, tell people to 'fuck off' but this is really just a conversation ender as in, 'i don't want to talk to you anymore'.

however, it is always hilarious to me, that the self-styled 'protectors of the weak', such as you beleive yourself to be 'anonymous', typically are shadow dwelling trolls who, when confronted with a coherent counter-view, jump immediately to the ad-hominem attack.

because i know you don't know what this is or why it immediately exposes you as an shallow thinker, an 'ad hominem' attack is one in which the arguer attacks the person and not the argument.

so, in your last post, rather than argue the point, which is, to beat a very hugely fat dead horse, is that a) morbidly obese people, when they die, are a huge problem to dispose of b) morbidly obese people, with rare exception, are responsible for their own health and c) as doctors who deal with death every day we are possessed of a twisted gallows humor, you simply jump to "you are disgusting, hateful, human garbage etc..."

i know it's wasted on you anonymous, because you are, and to be very clear here this is not an ad hominem attack because i am going to support is with reason, a cowardly, scary, ignoramus. you are cowardly because you attack us anonymously, you are scary because i do believe that, if you had the power, you would put the authors of this blog in jail or have us killed (that's where 'human gargbage' belongs right?), and you are an ignoramus because you have judged us to be 'disgusting, hateful, human garbage' when all of us here have dedicated our lives to curing disease and helping people.

the fact that we find humor in pain, that we get fed-up with the demands of the job, or that we are unhappy with the way the government has screwed our system does not change the fact that every time we go into work we do our best for our patients regardless of who they are or where they came from or whether they 'deserve it' or not.

shinobi, we mostly agree. i can only tell you that while i did not write this post (and would not have) i do think it's funny and that's probaby mostly because i know etotheipi personally. his bark is terrible but he can't bite. i think it's funny like i thought the movie M*A*S*H was funny. again, rather than cry about the morbidly obese or chronically depressed or schizophrenics who think they are Jesus or dead children from house fires i prefer to use the gallows-humor approach. please stop by anytime.

I have a chronic illness. I will struggle to manage it for the rest of my life. The last specialist I saw (at a nationally prominent university hospital) before I finally found a specialist who could help me (in a small private practice) belittled me and used sexist language (he basically said that I was an emotional, irrational female, and that nothing was wrong with me). I knew he would not take my concerns seriously, would not listen to me, and, ultimately, could not help me.

Today, I'm closer to actually being healthy than I have ever been. If I had stayed with that first specialist, I doubt this would be happening.

The chronic illness that I have has absolutely nothing to do with the choices I have made, but what if it did? Would I be any less deserving of proper medical care? That is a philosophical question for the ages, perhaps, but I think, based on my personal experience and on books like Groopman's, that a physician who thinks of his/her patients who are fat may compromise the quality of care those patients receive. I also work in a field of public service, and I try to consider how my own prejudices may affect my performance -- probably more than I realize.

I would not be on the road to health if I had not been respected, listened to, and taken seriously. The first specialist did not do those things because I am a woman. Who knows how difficult it would have been if I were a person of color, less educated, fat, etc.? (Not being a physician, I'm not sure how this would translate from my area of interest to emergency medicine.)

Dear Kathryn, Do tell, what is your chronic illness? I'm going to wager here that the super specialist told you that he could find nothing wrong with you but that the physician or provider at the local clinic told you that you have fibromyalgia, chronic fatigue syndrome, or, perhaps 'systemic candidiasis' or 'universal allegen syndrome'. Please do forgive me if I'm wrong but you came here with tales of a chronic illness which to me are things like diabetes, hypertension, lupus, hypo or hyperthyroidism, cancer, emphysema, asthma, or schizophrenia. If the super specialist couldn't diagnsose those problems then you were in East Timor. I really am anxious to hear about your chronic disease.

This whole comment thread kills me. It reminds me of when I posted a sweet tale of my daughter's wonderful party and all the memories I would hold in my heart forever, but since I called one of the kids a nickname to identify him in the story(which was funny in my opinion) because he had a peanut allergy, I got hate mail forever about how insensitive I was. I still get hate mail from random anonymous strangers and it was a year ago. This post was about how difficult it is to dispose of a large body, correct? It wasn't an attack on any person reading and if a person takes it as such, maybe they need to examine the feelings they have about themselves that led them to take it as an attack. It wasn't politically correct, and that is why it was sort of amusing. I don't make fun of other people, would never have written this but if reading this was so offensive why not just close the window?

People need to lighten up and not take everything so seriously! Also, people do make fun of skinny people just as much as heavy people. Skinny chicks don't get made fun of? Really? It's no big deal and doesn't have much of an effect of how I feel about myself because I know the person I am does not have much to do with the body I have but I get made fun of all the time for being too skinny and looking like I am about 12 years old. Etotheipi, feel free to bash skinny chicks any time you want to though. I have a sense of humor and can take it.

I know you don't need defending, but seriously, this kills me that people are so upset and not ballsy enough to leave real names attached to comments.

Wow! I tried very hard to be respectful, rational, etc. I didn't even use a pseudonym! I didn't call anyone names (like, ahem, "whale carcass"). I tried to be nice! I guess I don't get any credit for that.

911Doc, you win -- it's hypothyroidism. The second specialist helped me by switching medications. Is that "legitimate" enough for you, or do I need to present a doctor's note in order to have an opinion on the Internet?

See, here's the thing -- I'm white, but I'm still offended by racist speech. I'm straight, but I'm still offended by homophobic speech. I was born in the US and English is my first language, but I'm still offended by xenophobic speech. A person doesn't have to be a member of a group to be affected -- or offended -- by speech or actions directed at that group. Thank goodness that's not the case.

"First of all, fat chicks love to have sex, and are good at it, because they are so grateful for the attention. Second, fat people get sick and die more often, which is great for business. Third, and most important, fat people are great to make fun of." That's not funny, and is about on the level of your average third-grader. You may not know for certain exactly why that 45yo man weighed 780 pounds at the time of his death, but it's at least plausible that his family's poverty had something to do with it (http://www.nytimes.com/2007/04/22/magazine/22wwlnlede.t.html)

Best case scenario: this blog is truly just for venting, and what y'all write has no affect on your practice of medicine. Worst case scenario, it does. Like all of us, who go through life affected by our own prejudices, you may not be able to tell the difference.

i want to make it clear that while i am defending my friend etotheipi regarding his post i, ethically, by law, and for sheer self-preservation, HAVE to take every patient seriously and ASSUME THE WORST in each case.

if you care to you can read some posts on this site that will confirm that for you. the long and short of it is that, given the viscissitudes of EM, i CAN NOT MISS a diagnosis or i will be in court and my house will be gone.

in fact, there are a plenitude of posts here that will confirm that for you. here's a good one right here. and here's one you won't like but the gist of it is that even though everyone involved in this particular patient's care believed she was a drug abuser/drug-seeker, that she was, in fact, terribly sick, and that avoiding the easy out by following the stereotype probably saved her life.

etotheipi is a pathologist. he doesn't care for patient's until they are dead or need a pathologic diagnosis (usually in the middle of surgery), and he, unless i'm mistaken, never talks to his patients.

it may not please you that the 'whale carcass' had to be disposed of in pieces but this is the truth. in fact, avoiding patient contact is the way he likes it as stated here, and, at the same time, he's the guy YOU WANT TO BE YOUR PATHOLOGIST because he's a damned good one and might save your life.

if your initial physician did what you claim and didn't take you seriously because of the way you looked or any other form of appearance then he deserves ridicule and perhaps a lawsuit.

i truly do wish you well and hope your therapy and treatment brings you back to good health.i believe you are new to our little rant here. if i am correct, give us time, we will grow on you (kinda like a fungus).

well damn, you won't like us very much. but let me make one little quibble here. you speak as if it is possible to divorce oneself from innate prejudices. you also imply that it is wrong to act on said prejudices.

well, you are the one claiming to be a white heterosexual female. i don't care what you are. seems like you may care a lot more than us.

if you can think of another thing to call an 800 pound human other than 'fat' then great, go ahead. i hope it helps you in the extremely complicated mental game you must engage in to weigh prejudices and guess as to other's motivations. for me, i call 'em as i see 'em because otherwise i could not do what i do. obtw, am i black? asian? you know, asians are really smart and black people, for about twenty years (along with women) have been admitted to medical schools in front of more qualified white males in order to 'balance the scales' that you appear to care about. actually, i'm part eskimo and comanchee indian and romanian. and i'm a heterosexual with strong metrosexual tendencies not amounting to wanting to perform fellation on another man. can you pigeon hole me yet?

identity politics is killing this country and killing our health care system. skirting around obvious truths and taking the 'compassionate' road has produced a population of entilted patients who are driving many of us out of the profession. it has created a whole host of 'syndromes' and 'alternative therapies' which do nothing but keep the patient in a chronic state of pseudo-illness (i am not including you in this group).

'no matter' you say, 'better to get more compassionate folks in medicine'. WRONG.

unlike a term paper or a PHD thesis there are very clear right and wrong decisions in medicine. there are surgeons who will save your life with their incredible skills. there are surgeons who will kill you on the table because they are terrible. cardiac surgeons and neurosurgeons and pediatric surgeons take about 8 years to train after medical school, and that, as you know, is four years, hardcore, after four years of college. residency? 8 years of absolute hellish sleep deprivation, less than minimum wage pay, and tremendous debt accumulation. and, oh by the way, all you need to be is perfect every time.

if you would prefer to die on the table with a compassionate surgeon then great. if you want results then you MIGHT have to put up with some 'uncaring' physicians who are, as a group, absolutely exhausted and at our wits end due to a host of factors, not the least of which is patients who have spent a lifetime abusing their bodies, abusing the system, and abusing the nurses, paramedics, and docs who take care of them.

the crash is coming. people are dying today because of a lack of specialty surgeons and no one wants to be one anymore.

it looks as if your candidate for the presidency is down for the count. no matter, neither party right now has the balls to say what etotheipi and the other authors of this blog all believe and that is as follows...

with all the blame to go around regarding the current state of health care in the US (and it is still the one country in the world where i would, if forced, have my heart attack, aneurysm, or cancer treated), the lion's share lies at the foot of the federal government and voters who enabled the government to shift responsibility for one's health away from the individual and onto 'society'.

That's a fallacy of bifurcation -- assuming that you can either have a competent physician or a compassionate one. Ideally, you should have both. I never said I would prefer compassion over competency. If that first specialist had been competent, he wouldn't have treated me like a hypochondriac child just because I'm female. I shared the fact that I am white, heterosexual, etc. to make the point that just because, in your eyes, I have a "legitimate" chronic illness, I am no less capable of objecting to what was written.

I don't think "fat" is necessarily a pejorative word. People who equate being fat with being lazy, stupid, immoral, etc., probably do.

I'm always puzzled by people who appear to assume that THE INDIVIDUAL! acts in a vacuum separate from the rest of the world. Maybe I'm biased after being in a relationship with a sociology PhD (who, by the way, also has a chronic illness -- a gastrointestinal one, if you're keeping score -- that went undiagnosed for years, during which time he almost died), but I think the world is a bit more nuanced than that. Just saying.

I'm not sure how you think so-called "identity politics" are ruining the US health care system. In my mind, the millions of uninsured people are the bigger problem. What's the use of having the best health care system in the world if not everyone can take advantage of it, and the focus is taken away from preventive care to emergency medicine?

I'm not sure who you assume is my preferred candidate for president ... I'm an Edwards supporter right now.

Responsibility, you are medical professionals and yet when anything goes wrong in the medical profession, it is the fault of somebody else of patients of 'gutless' politicians of political correctness, anything/one but you, you are always the perpetual innocents. Always sinned against, never sinning.

Diets do not work healthy eating doesn't make many fat people thin, but you think that if you shout and scream and describe dead fat people this is going to re-order the universe and make the unworkable work is it? That's genuinely amusing.

I predict that as there is no way of reliably turning fat people permanently into thin people, you are going to see more dead fat bodies as fat people die, the same as thin people- yes everybody dies, and some people die young- which is great for you because you've got so many laughs to look forward to.

Look. This is a story about disposing of a fat guy's immense body. That, to me, is funny in a odd, dark and surreal way. I am being intentionally inflammatory and hyperbolic in my side- commentary to make it funny (you may or may not agree that this was successful). When I do this I will likely offend some people. Some others might find it amusing.

When someone makes a joke about a taboo subject (let's say a joke about molesting kids), you may find this disgusting and believe that the person who made the joke is evil. Maybe you will think this is hysterical even though it is tasteless.

If you can't take the post as intended: a dark story with some attempted humor, then you are incredibly thin-skinned. Or maybe incredibly thick-skinned now that I think about it.

kathryn, i had you pegged for hillary but edwards makes much more sense. a lawyer who made his fortune suing physicians and who convinced a jury to find against an OBGYN for not delivering a child with CP correctly. the causation was not there but there was Edwards with his perfect hair tweeking out the tears. love his huge mansion and clear cut forrest too. if you are an edwards supporter then we do not have anything in common other than an appreciation of finely coiffed hair.

you misread me, i said you 'might' have to put up with an asshole to get a competent sureon... 'might'.

i know who you are now. best of luck to you and your husband. i hope the next president can fix your problems.

mumboj: you also need to read a bit closer. i am willing to accept mounds of blame for everything, everyday, and my money is where my mouth is friend. if i mess up i'm in court. and yet, you know-nothing, i am in that ER every day treating all comers regardless of their ability to pay and with the same care each time... excellence is what you get from me.

the fact that people like you are out there in droves is the thing that, in three months now, is getting me out of the professsion. good luck in 5 years finding a competent physician to care for you or your family. YOU, and the other angry-entitled here, are the reason that "up to 30%" of boarded emergency phsysicians are seeking other careers in the US (American College of Emergency Physicians, Monthly Newsletter, Jan.'08).

obtw, i heard this great joke about a crippled lesbian pygmy the other day...

one more question 'mumboj' or jumbo-mae' or whatever, could you provide me with some examples and citations from peer reviewed medical journals about how diets don't work etc... because i think i may be superhuman, and shari ann too, as we have both had success with weight loss with just this method!

and we would never want to reorder the universe and convince the morbidly obese that the first person to help them has to be themselves, after all, that would work, and then we'd have less business! you figured us out damnit, we are all about the benjamins.

I read the posts you recommended on this blog -- hell, I read shit like Groopman's book and watch "Mystery Diagnosis" for fun, so why not this, right? Then I read the comment threads. I suppose I should be grateful that y'all didn't just tell me to shut up and fuck off.

Then I read this:http://www.nytimes.com/2008/01/06/fashion/06professions.html?em&ex=1199941200&en=3ee8fd735a4090ab&ei=5087%0AI appreciate the pressures physicians like you face. A friend has parents who are both in medicine (internal medicine & gynecology, respectively), so I've heard first-hand about malpractice insurance, lawsuits, etc. I think problems like the lack of universal health insurance (which would keep a lot of patients out of your ER), poverty, and unequal access to healthy foods are the major problems, not patients.

Also, Etotheipi -- I understand that you were trying to be funny. You weren't. My idea of "funny" is The Office, Eddie Izzard, Margaret Cho, Kathy Griffin ... so I don't think I have a delicate constitution and just can't handle a joke. Shit, Kathy Griffin calls Catholic priests "kid fuckers." She's funny. You're not.

Thankfully that's only "might" have to put up with an asshole to get a competent surgeon. I've known three personally in my years as a patient, and luckily, they were all competent and none were assholes.

As for patient "entitlement" ...yes, this is a serious problem that cripples our system in America. No question about that. And it's not just health care, either. It seems no matter what service type industry you're in, people are often very demanding, miserable, and self-righteous. Perhaps cynicism is a defense against this.

And "syndromes" (like CFS or whatever they're calling it this minute)...this kind of stuff is so insane that it almost makes me want to start my own blog. I've see too many loser types live off my hard earned money from these sorts of things to be rational in my analysis.

So really I am sort of bitter and cynical like the threads I see through these posts, but...I try not to be so much so that I lose sensitivity. It isn't easy, sometimes, and I know that. It just touched a nerve.

"As for the former fat chick with the wasting disease, are you really equating sound advice about weight management with encouraging someone to get sick to lose pounds? Are you high? Is that why you have the munchies all the time?"

What a diagnostician! The reason I'm still losing 20 pounds/month must be because... I have the munchies! I really hope you're better at this when you have cell samples to go off of, dude. :)

But in all seriousness, when did this become "weight management advice"? You're writing a nasty rant about fat people because you're frustrated with the aftermath of a fat person's death. I can understand your frustration. It's a ridiculous situation. But I, unlike the 'fat chicks' you've been dissing in this thread, can't believe that this venom doesn't show in your practice. I can't believe that you don't let it slip with your "normal" weight patients. I won't say you're lying to yourself, but please, step away from that Monster Prickburger.

And I know that when I call people on these irrational attitudes towards weight loss, they talk about *doctors.* "Oh, even my doctor made fun of my weight, so I must be really fat." (No, lady, you're 5'8" and 165 pounds, that's barely overweight even by the somewhat dubious BMI.)

If you think you're not one of the doctors contributing to this, if you think you hide your hatred for and fear of overweight from all your patients, I'm glad (it's better than KNOWINGLY inspiring eating disorders) - but you're probably wrong. Let's face it - you weren't talking about a 780-lb dead guy when you waxed poetic about how fat chicks love to have sex.

Kathryn-It's sad that you can laugh at children sexually and menatally destroyed by trusted clergy but when you hear an insensitive fat joke you can't take it. Pathetic. When a joke hits a little close to home, all of a sudden I'm an asshole. Maybe I'm not funny to you. Fine. I think I'm a riot.

FWIW, I thought that this post was hilarious, EVERYONE is far too sensitive, and we should all just chill out.

Incidentally, I used to be overweight, and I suffered from chronic pain and general malaise. I self-diagnosed with all kinds of things like fibromyalgia and chronic fatigue. I, finally (and luckily) found a doctor who gave it to me straight - I was 50 lbs overweight.

She gave me some simple diet tips but told me it was on me to change my lifestyle. I made the changes, I lost the weight, and, just like my doctor said, all my symptoms went away.

It was hard. I was hungry. Exercising hurt. But I did it anyway. And now I'm better.

When I thanked my doctor for her straightforwardness, she thanked me back for actually taking control of my life. Apparently, not that many people do.

So I realize that it must be enormously frustrating to know how many people's "chronic" conditions are caused by obesity. It must further be frustrating that, a) they can't tell their fat patients the truth without being subject to complaints, and b) the vast majority of their fat patients will never take any responsibility in their own health care because they have chalked their choice to be fat (and, barring real medical problems, it is a choice) up to the fickle finger of fate.

Even if you're fat, and even if you believe that you can't do anything about it, you can certainly see that this is a very frustrating position for the doctors to be in. They've taken an oath to help their patients, there's a cut-and-dry cure to the patient's problems (loose weight), they're giving their patients sound medical advice (loose weight), and the patients refuse to HTFU and let themselves be hungry for a while. As a result, the docs watch their patients get sicker and sicker and finally die - all from a curable condition that was diagnosed easily and correctly from the beginning.

I'd have a dark sense of humor too.

So, the doctors need a space to vent. This is their space. Try to respect it. Before you chastise them for being callous, think about how it would feel to watch people with treatable conditions die because they lacked the fortitude to change their lifestyle. Be honest with yourself - might you use humor to deal with that?

Fat people also need a space to vent - but this isn't it. Set up your own blog, call it "BBQOD", put up snarky posts about how western medicine just doesn't understand your condition, make fun of callous doctors. Then try not to be too hard on the folks that troll your comments telling you that they understand your life better than you do.

Ok, you redeemed yourself a bit by quoting Eric Cartman...that show is one of the funniest I watch with any regularity. Perhaps if I look at some of the stuff on this blog with the same perspective, it wouldn't seem so harsh.

Someone was asking for support from peer reviewed articles for the assertion that intentional weight loss attempts don't work in the long term for the majority of people.

Some time back I wrote the following concerning this topic:

[...]There seem to be physiological mechanisms that lead to a lowered metabolism during dieting. After a return to normal food intake the low metabolic rate is kept up for a while, which leads to a faster weight regain. In fact, some studies suggest that more than 95% of all weight loss attempts are followed by a complete weight regain in a five-year follow-up period (Garner & Wooley, 1991). This is true for all dietary and behavioral modifications used to lose weight, no matter if it is a medically supervised weight loss program or a fad diet. Often the weight before the diet is even exceeded (Garner & Wooley, 1991). A study by McGuire, Wing, and Hill (1999) seemed to paint a somewhat brighter picture by suggesting that 25% of people who have lost weight one or several times in their live (either intentionally or unintentionally) maintain a weight at least 10% lower than their maximum weight for five years or more, however it should be noted that the study relied on self-report and that it did not assess how many weight loss attempts preceded the final maintenance. Since some people tend to regain more weight after each successive weight loss attempt it is possible that even supposedly successful participants had a higher weight than before their first diet (in fact dieting in normal weight teenagers does predict later overweight; e.g., Field, Austin, Taylor, et al., 2003). It has also been found that weight loss becomes harder depending previous cycles of weight loss and weight gain (Hart & Warriner, 2005)[...]

I am not a medical professional, but I have worked in the medical field as a full time volunteer for a year before I started my college education some years back. In my experience patients of all sizes do sometimes behave like super demanding assholes. In fact, might even do it more often than people in an average every-day situation since they are often in pain, scared, and stressed. A medical professional has to be able to deal with this at least most of the time (after all nobody is perfect) without blaming the patient - otherwise he or she is not doing his or her job properly.

As a fat woman I can tell you that the bias medical professionals have when it comes to weight does show - even if they don't intend to let it show. I wouldn't even mind if a doctor would ask me to consider weight loss if he or she had previously asked me about my weight related history (which includes a chronic eating disorder as well as several short-term successful weight-loss attempts on which I have lost up to 35% of my body weight in a very short time – which lead to symptoms such as amenorrhea). However, no medical professional has yet done so. Also, I have had health problems blamed on weight that might in many people be weight related - however, my specific situation made it unlikely that this was the case for me. For example, I developed hypertension AFTER I had lost 40 pounds and my blood pressure normalized later on with increased exercise and stress reduction although I regained some of the weight.

In the light that social rejection has been shown to be a powerful determinant of not only mental but physical health the negative attitude that many health professionals openly show towards fat people indicates either that they don't really care that much about their patients health or that they are completely oblivious concerning the health consequences of their behavior for their patients. I am willing to assume the second possibility - I still believe that the majority of doctors and nurses truly want to help people become healthier – but if the second explanation is the correct one this is still sad enough.

I am doing my best to improve my eating behavior without focusing on weight and to exercise regularly without becoming obsessive, just as many other fat people do. It is called Health at Every Size, and it does indeed lead to improved health (though usually not to weight loss). There has been at least one study indicating the effectiveness of this approach:

For the (hopefully) open-minded and professionally behaving health care providers posting here (despite the rather nasty and prejudiced things that they have written) this should be an approach worthwhile to check out - at least for the patients that don't "comply" for whatever reason with weight loss advice.

The MINUTE someone calls a fat person fat, the fat person replies "Don't you think I KNOW I'm fat!? - heaving sob!!!!". Yet doctors are supposed to delicately approach the subject with their patients like maybe the poor fat person has been in an isolation chamber for the last twenty years and just hasn't caught on that MAYBE some things would improve with weight loss. Stop expecting people to kiss your ass. Realize that society hates a weak fuck.

Here is how I lost weight:I eat when I'm hungry and stop before I'm full. I eat vegetables, fruits, lean protein, whole grains, low fat dairy and heart healthy fats. I occasionally treat myself. I practice portion control. I increased my activity (I started with throwing away my remote). I kept picturing myself waking up in a nursing home without my feet. I am tenacious. I realized I really really wanted to get laid, which had more to do with actually wanting to go out among other humans than being able to find some douchebag willing to fuck me.

Shari Ann - so you have lost weight. Big deal. So have I - as I said above I have lost up to 100 pounds several times in my life. The problem is not losing the weight but keeping it down - for more than, say, one to five years. Since dieting and weight cycling is psychologically and physiologically stressful I would rather not attempt to lose weight anymore until there is a method that has been proven to be safe and to work in the long term for the majority of people.

It's great that you are able to eat when you are hungry and stop when you are full, but for someone like me who has struggled with an eating disorder since she was 11 years old this is not an easy option. I am not saying that every or even the majority of fat people have an eating disorder (in fact, many of my fellow fat people would strongly object if I did). All I am saying is that what worked for you is not an option for everyone, and the reasons differ from person to person.

As for your comment on throwing away the remote: I know I MUST be lying about this, but I don't even own a TV. I also don't own a car, which means I am usually biking or walking wherever I need to go. Does every fat person do this? No. But not every fat person sits in front of the TV the whole day either.

Thanks, anonymous, for taking a single word of two quite long posts totally out of context. If anybody here really thinks that it is a realistic option for a person (fat or thin) with an eating disorder of which nature ever to just start listening to hunger and satiety cues and act on them you have no clue whatsoever of the nature of eating disorders. In addition, intentional weight loss does not mean that you are eating according to hunger and satiety cues, not even if you are fat to begin with. Similarly, holding a high weight stable does not automatically mean you are overeating. It's different if you are constantly gaining weight, but overeating is only one possible reason for weight gain. Considering that there have been cases of people that went undiagnosed with a serious illness because their doctors wrote of their weight gain to simply overeating I would be very careful with things like that.

ETOTHEIPI said- 'One of my local pathology colleagues had a gastric bypass patient die today – he was 45 years old and 780 pounds. I think his BMI was, like, a trillion.'

Hmmmm, the tone from most of the agreeing posts I've seen on this thread seem to indicate that the 'ginormous whale-carcass' failed to exercise personal responsibility and refused to do something about his weight. Yet, not ONCE in any of the subsequent posts, does any one mention the fact that the man seems to have died on the operating table trying to DO JUST THAT. The man's DEAD and he can't even catch a break. Nice. Or, maybe my persistent whining is causing me to confusing Gastric bypass with some other cosmetic procedure. No- It must be the timing thing. 'Fatty waited too long and deserved what he got'. . . No, that's not it either. How about- 'Fatty should never have let himself get that big in the first place'. . . . Yeah, that's it. The All Knowing have spoken. Bow down and surrender your fat.

As far as having a little empathy goes ( I believe most Non-sociopaths find this desirable), I'm not a Dr. I'm about as far into the periphery of the Med industry as one can get, actually, but I have had friends in the ER and heard stories of having to go down into the Blood & Mud on a daily basis. I can understand how one might need a thick suit of emotional armor to deal with all of that. However, I also know people in law enforcement and the military who's situational circumstances you may or may not find similar. Here's the thing; There are things that they WILL NOT discuss with anyone who is NOT from those communities. Why? The common answer; Civies wouldn't get it.

You've chosen to open this particular area of mud, blood, and guts to the public. I hope your not surprised that us 'Civies' don't A) Like it or B) get it. Frankly, we're not required to do either and, bonus, since it is public, we are at liberty to respond. Does it surprise you that we would? Because we're fat (fatty should just STFU and take it!)? Or compassionate enough to want to, at least, TRY to understand (Fatty lovers should stop trying to defend them and just STFU!) One thing you might want to consider in the high stress field of Emergency Med. No matter how good you might THINK you are. No matter how much you might THINK you need the callus attitude, or how much you THINK it doesn't effect you, guess what? It. DOES. I'm sure you've heard of it. It's called Burn-out and even the most confident and ego-sure Dr., RMD, or RN's who use these coping strategies can suffer from it eventually. The tragedy comes from not recognizing it's almost inevitable effects soon enough to walk away before somebody or SEVERAL somebody's die.

I am SO late coming to this thread, but I found you through another blog and I think I'm in love.

So, since the horse is now splatterting appetizingly, I'll beat it a bit more:

-Am I the only one who thinks the word "disorder" being applied to lifestyle issues is one of the worst steps we could've taken?

-Obesity is a disease to the insurance companies, yes. I think they hate that. I could be wrong. I suppose we needed a code? We have a perfectly good word in english: CONDITION. STATUS. STATE. Disease just doesn't work really, does it?

Absolutely disgusting. Oh, sorry, I'm not talking about people with weight problems... Be it within their control or not. I'm talking about the malicious delight these health care 'professionals' take in ridiculing people based on their weight. And I do mean malicious. What is WRONG with you people? Maybe some folks need help with losing weight - how nice for you lot to be around sniggering behind their backs and pointing the horrible finger of derision at them by posting their personal difficulties online.

At least you've shucked the guise of caring providers. There's no veil of 'concern' over your viscious tirades. You clearly find fat people revolting and frolick in your anonymous forum, reviling them.

Tell you what, ladies & gents, health care workers and poseurs alike - I'd rather be 500lbs that have the black, stinking, cruel hearts & souls you have. IMHO, the epidemic of ignorant, callous trash populating our already despicable health care system (worst in the free world) is the problem - not the overweight.

Bigoted hate is by far the more disgusting problem, here and many posters to this thread show that it's alive and well in this supposedly Politically Correct era -- An era where racial or sexual orientation epithets have simply moved on to 'disgustingly obese' and so forth. Being 'once overweight myself' doesn't excuse you from being a human being, either. Simply because you have triumphed (for now) where others have failed doesn't mean you deserve any more consideration by health care workers than anyone else. In fact, the very HINT that most or all 'fatties' are willingly flaunting their conditions and simply 'refusing to lose the weight' is further proof that many of you claiming to once have been fat are simply lying to justify your cruelty and unwarranted hate.

Corey - I guess Neo-Nazis should have a forum to 'vent' their 'frustrations' at what they perceive to be the invasion of blacks and Jews of the world? Or haters of Gays and drug users so they can lament the spread of AIDS? At least nobody is relying on Neo Nazis and Gay-bashers to CARE FOR THEM under policies they have PAID FOR.

That's the difference, pal. We're talking about licensed, oath-taking professionals, here. If they can't deal with patients who have weight problems without puking up the kind of disgusting bile on display here, then they're in the WRONG BUSINESS. There's no place in the world for this garbage - especially from the people we're supposedly paying and entrusting to take care of us.

first, for someone accusing us of 'hate' i see that your post is full of, well, seething, malicious hate.

second, no one is 'pointing fingers at anyone behind their backs' because to do that, well, we would have to be identifying someone wouldn't we?

third, 'guise of caring providers'? what guise? read the header to the blog. we are burned out and bitter and tired of taking care of people who chose not to take care of themselves. be fully aware though, dear friend, that you are sadly mistaken if you think that there is any link between appearing to be 'caring' and being an excellent doctor.

all of us here practice. none of us here say aloud the bubbles above our heads when we encounter the 400 pound woman with sore knees who has refused all advice at weight loss, gastric bypass surgery, lifestyle change and wants us to 'tell her what's wrong'.

you are an incredibly ignorant person if you believe that our health care system is anything OTHER than THE best in the world. i mean completely fucking ignorant. show me the stats that put the quality of US healthcare anywhere but in the top three and i'll show you lies produced on specious reasoning and the mantra of 'accessibility'.

you and people like you are THE REASON that people like me and my colleagues are leaving practice. good luck with the 'caring' doctors that come to replace us, they are going to have to be tremendously caring to deal with an angry fool like yourself.

next, 'bigoted hate', look in the mirror you prize fool. read your post you ignoramus. you see, while you call us names in an ad hominem attack i point out that you are, in fact, an ignoramus for your absolutely fantastical external locus of control, woe is me diatribe. you cite no facts, you only yell.

next, if you think that political correctness is anything other than the vilest poison and lie ever to see the light of day in this country then you are a bigger ignoramus than i can imagine.

next, i don't thing i am off base here, but i think you have a chip on your shoulder the size of the fucking moon about your weight. guess what, no one can change it but you and no 'caring doctor' who tells you anything but this is going to add one day to your self absorbed and pitiful existence.

next, YES!, you freaking communist, neo nazis and moon-worshipers and gay lesbian dwarfs and stupid self pitying folks like yourself SHOULD have a forum to vent their frustrations. it's called the FUCKING FIRST AMMENDMENT you glorious excuse for a human.

you see, if you force the opinions underground then there's no dialogue, only bloodshed and oppresion. that's the genuis of America and the western world... debate in the public square. idiots sound like idiots and are quickly disregarded and shamed. it's working really well here for you after all so i'm only upset that you didn't have the courage to identify yourself, you troll.

next, you are reading the post of a FUCKING PATHOLOGIST YOU DUMBSHIT. he does not take care of live patients. he deals with autopsies and tissue diagnoses. he HAD TO FIND A WAY TO DISPOSE OF THE BODY. did you not know that a person this large would have to be cut into bits to bury them? neither did i but, perhaps, he has done a whole bunch of people a favor by pointing out this grim reality to them rather than soft-pedalling their life threatening conditions.

next, because of governmental intevention, which, i just bet, you think is the answer to our terrible system, we are paid by only about a third of our patients. also, since health care is now seen as a 'right' by people like you, no one budgets for it, no one plans for it, and ALL of this is dumped in the nurses and doctors laps.

next, medicine is no longer a business you economics whiz, because, in the ER we take care of EVERY SINGLE PERSON WHO SHOWS UP REGARDLESS OF THEIR ABILITY TO PAY AND REGARDLESS OF THEIR STATE OF DRUNKENNESS, FATNESS, REGARDLESS OF WHETHER THEY ARE CRIMINALS OR ILLEGAL ALIENS OR MURDERERS AND WE DO IT ALL DAY LONG EVERY DAY 24/7 AND WE ARE FUCKING GOOD AT IT.

go have your roll over car crash or myocardia infarction in mexico or bangladesh or peru or russia and see if you get one tenth the quality care you would get ANYWHERE IN THE UNITED STATES up to and including a helicopter flight to a trauma or specialty center with the best specialists and nurses in the world all focusing on you and not caring whether you have the ability to pay or not and not caring if you weigh 500 pounds or 75.

next, you are not paying me anything 'anonymous', you are not 'entrusting' me with anything, i do not work for you. i don't know where you get off speaking like you are entitled to respect just for being able to get angry and throw words around on a blog you arrogant coward.

'policies that they have paid for'. what fucking policies are those? EMTALA, the law that mandates we treat everyone with an 'emergency' without regard to their ability to pay and does not define 'emergency' IS NOT FUNDED you incredible excuse for a homo sapiens.

finally, and with all respect, go chill out, have another donut, and go make someone else's day miserable. go get your own blog and make an idiot of yourself there. fucking, godammed troll asswipe douchebag.

You people kill me. Yes, I did just say 'you people'. The fat, obese, large, robust, rotund people that, unfortunately, the rest of the world identifies the U.S. with. You have become the fodder...the poster-children for the Unites States of America and our overindulgence with food, drink, calories, and excess in general. Pathetic. Fortunately, you fat fucks keep me in business. How many times do I have to hear, "I have slow metabolism" before I blow my fucking brains out? GET OFF YOUR FUCKING ASS AND EXERCISE!!! I could weigh 225 pounds if I wanted to...but I choose to exercise hard 5 days per week and I weight 175 pounds. FUCKING SHOCKING ISN'T IT! Let's eat at Carl's Junior tonight, honey. It'll just be easier. That Jay Leno, he's one funny guy, huh sugar? Pass me that third bag of Cheetos sweetheart. Pathetic fucking lazy over-eating fucks. Best part? Job security for me and my boys. This argument going on here is a joy to watch. Go ERDOC911. You are genius. PERSONAL FUCKING RESPONSIBILITY FOR OUR OWN BODIES. HUH? WHAT? I OVEREAT? HUH? I DON'T EXERCISE? WHAT? I AM GOING TO BE FAT NO MATTER WHAT. MAMA IS FAT. DADDY IS FAT. JUNE AND LILA ARE FAT - THEM'S MY SISTERS. BUBBA'S FAT...OH MY FUCKING GOD!

This is a little bit for both sides of this post..For US and our faithfull: I can see how E's intial post could be seen by the virginal readers as vile, hateful, mean spirited, etc in a global sort of way..But..

For them: Fuck off!!! You have no idea of what our jobs are like. What other profession/job does it's best everyday to take care of everything that comes thru the door knowing that if there's even an unanticipated less than satisfactory outcome thru no fault of ours, you can get sued and hassled for years because of a patients poor life choices?!! I didn't force the Big Mac down your throat for years, make you smoke, stick the needle in your arm, stick my finger down your throat for years to produce the piss poor protoplasm you've become and I sure as Hell can't fix you on Saturday at 3AM!!!And I/we can't complain about you to anybody or sue you because you bled on us, vomited on us, screwed up our backs moving your fat ass!!This blog is the only place (except behind closed doors in a hermetically sealed room)were we can even talk about the rigors, stressors and crazy shit we deal with DAILY! Now don't misconstrue this as we don't occasionally see nice people or save a life here and there and someone says thanks, because occasionally that happens. However, the more likely scenario is that you have no idea that what I just did in 3 minutes saved your POS life and you won't remember my name, will bitch when you get the bill(if you gave us a real address!) and you'll never say "thank you" And I'll have a 1 in 3 chance that you will actually pay me for doing it! So, HTFU and don't come back if you can't stand REALITY. If, however, you wish to continue to read us, then please check the worthless release box at the bottom of the blog which acknowledges the fact that you may actually learn something about real life and hold us blameless for your life from here on to Eternity..

>>What other profession/job does it's best everyday to take care of everything that comes thru the door knowing that if there's even an unanticipated less than satisfactory outcome thru no fault of ours, you can get sued and hassled for years because of a patients poor life choices?!!<<

Cop. Firefighter. Military. Airline Pilot. Although with some of these professions, if they screw up they only risk getting THEMSELVES killed (Arguably a lot less pleasant than a law suit). However, I think we can off-set that with the fact that they sometimes only get SECONDS, if that, to make the right decision.

>>And I/we can't complain about you to anybody or sue you because you bled on us, vomited on us, screwed up our backs moving your fat ass!! This blog is the only place (except behind closed doors in a hermetically sealed room)were we can even talk about the rigors, stressors and crazy shit we deal with DAILY!<<

Nothing wrong with complaining. If it wasn't part of human psych I, personally, think we would have wiped ourselves out a long time ago. There is, however, a difference between complaining and malicious hatred. One can generally get a clue about when they've crossed over the line by the way others respond to them. Take a little time. Scroll through the thread. Seeing a pattern here?

As for this being the 'only' place where you can discuss this, I kind of doubt that and for some of you, I seriously hope it's not true. Very few organisms have the ability to survive in a vacuum. Those that can't and, for whatever reason, find themselves in a bottle usually end up taring themselves apart.

>>So, HTFU and don't come back if you can't stand REALITY. If, however, you wish to continue to read us, then please check the worthless release box at the bottom of the blog which acknowledges the fact that you may actually learn something about real life and hold us blameless for your life fromhere on to Eternity.. <<

I, for one, can stand reality just fine. I live here after all. The difference is I can appreciate OTHER PEOPLES reality as well as my own. Let me ask you this; How well do you, actually, get to KNOW any of these people? Do you get to KNOW that the person with the needle in their arm only started doing it because that's what everyone in their family does? Do you get to KNOW that the one sticking a lit cigarette into his/her tracheotomy hole has tried to quite every year since they started? Or KNOW that the the one who weighs 700 pounds has lost and re-gained their way up to that weight throughout the course of their lives? How about how well YOU deal with 'reality'? Think you could deal with having to decide which of your children you can take with you because the Junta is coming and you can't carry them all? Think you could deal with informing on a childhood friend because you know that what he posted on the internet will buy him, and anyone he associates with, a bullet in the back of the head? This is Reality too. Fortunately for us It's unlikely that you or I will ever have to deal with it. However, I can acknowledge that some people will and DO and I'm not in healthCARE. But you are.

second, if there is are different realities for different people then there is no reality and none of us have any basis at all on which to make judgements. so, if there are separate realities for different people who the fuck cares?

if, however, there is such a thing as 'reality' then there is no one, and i mean no one, in a better position to judge folks in regards to their medical problems and how their choices impact them than physicians.

I am really late to this post... but damn I'm in love with you guys even more after reading this. And for the record I think this post was hilarious and sad not for the guy that died but for the stress the poor family was going through. Oh and I'm a FATTY!!! Who's fault is it? My own. Why? Because damn if I don't love that Cuban Food.

However, after being told I was diabetic after living a what seemed like a lifetime of my father's limbs get chopped off, watched him go through hyperbaric chamber treatments to cure wounds which in turn caused deafness along with the the retinal degradation that was causing blindness, I decided I better get my shit together! I have lost about 50lbs so far by moving more. So no I don't feel sorry for the other FATTY'S out there, the reality is we are greedy shits who put too much food on our plates and then lay on the couch and watch to much TV.

Etotheipi, the only thing I can think that you said wrong is this...

I'm not good at sex because I need the attention, I'm damn good at sex cause with all those damn blond haired skinny bitches in the world I have to keep you motivated and coming back. HAHAHAHA Besides damnit, when you drop us for the skinny bitch we atleast have had really great sex to get us through our dry spell. Damnit,,, my husband's right I should have been born a man...

How about this, since we are facing an energy crisis, turn their fat sorry over burdening carcasses into fuel. Whalers did it for years with whale blubber (fat), why not these people? When you are morbidly obese you do not die with dignity. They usually have become a burden on society or at least the loved ones that have to take care of them, feed them, bathe them, wipe their asses because they can no longer do so for themselves. Why not in death become something useful. How about turning the extra 400 pounds of fat into fuel? Right now they are turning corn into oil, plastic, which is all biodegradable, why not animal fat's as well? To inhumane? Not really they're already dead. Disrespectful to the dead? Were they really respectful to themselves when they were living? Not really if they allowed themselves to become so obese that they died because of it. I have no remorse for people who get so large that they can no longer take care of themselves. If this makes me a bastard then so be it, but get off of your [large] carcasses and do something instead of getting a finger workout by flipping through the channels.

Bilt4hugin: Gastric bypass, if I recall correctly, requires a certain weight point to be reached to make the operation safer, or at least doable. Reaching this weight point would require a new diet, which was probably mentally/effortly out of reach of the fattie in question, the reason he had to have the surgery. It's like a catch-22.

For anyone hating on the poster here, you're entirely missing the point. He's not hating on the morbidly obese because they're obese, he's hating on them because they're selfish: They end up making a tragic event for their family even more tragic by making their ceremonial disposal an even more unpleasant event. It's one thing mourning your loved one as they're being cremated, but knowing that you have to have your loved one chopped into pieces like a piece of meat prior to being cremated, and then watch them being cremated one piece at a time must be a horrible, horrible experience, and one that I would feel incredibly selfish to have to put my family through.

Firstly, as has been said before: nearly all of america's health problems are the result of individual choices. I work in hospitalist medicine and 98% of my cases are a result of diet and lifestyle. Rarely do I see a purely hereditary or genetic disease. Instead I see fat diabetic smokers who refuse to change and then are on disability and expect ME to pay to come take care of THEIR problems without lifting a finger to help themselves because I've got the bill covered. Screw this.

Second. THERE IS NO WAY AN 800 LB PATIENT HAS MADE ENOUGH OF A CONTRIBUTION TO SOCIETY TO PAY FOR ANY OF HIS BILLS!!! I, and hopefully the ignorant fool who made this comment, and those who share his sentiments, are paying for HIS bills. I can forgive the ignoramus who is working and contributing, but not the lazy moron who wants a free ride.

"Listen, I have nothing against fat people. First of all, fat chicks love to have sex, and are good at it, because they are so grateful for the attention. Second, fat people get sick and die more often, which is great for business. Third, and most important, fat people are great to make fun of."

I know this is a dead thread. I am way too late to this wretched excuse for a party. But I shall say this anyway since, to have this comment removed, one of those responsible for the blog will have to read it first.

You, whoever wrote this post, are a waste of space and oxygen; bigoted, cruel, ignorant, misogynistic, soulless and inhumane. I'm delighted I'm not an American citizen and that I shall never make your acquaintance, even on a mortuary slab. And you had best believe that this fat woman I wouldn't sit on your face for any reason other than to silence you poisonous mouth. Even if I shat in it, that would taste sweeter than what just came out of it. Merry Christmas to you too.

This is disgusting. The person who wrote it and most of the commenters are all horrible, wastes of everything you are. I honestly hope you all are hurt.

Like the person above me, I know this is dead (like I hope you all are) and I know no one will see this but HOW DARE YOU FUCKING CALL YOURSELVES DOCTORS AND NURSES YOU PUTRID MONSTERS IN HUMAN SKIN! HOW DARE YOU! You are worst kind of thing on this Earth. You are hateful, sad, and a horrible person. I'm a fat woman and guess what, I don't crave attention especially from, well, there's no word to describe how disgusting you are. You are far more disgusting than the fat people you put down.

Unlike the person above me, I hope I DO meet you one day so that I can, soon after, go to prison for things I would do to you.